Live SessionModule #6
Patient Safety at a Glance: Ch. 20
Patient Safety in Primary Care
HCM520
Quality and Patient Safety
Introduction
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1 in 50 primary care involves patient safety incident
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1 in 20 of those involves substantial harm
In England (2008-2009), 303.9 million general practice
visits
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6 million will experience safety incident
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300,000 will experience substantial harm
Including pharmacy, lab, dentistry, nursing, etc, errors
would be higher than estimates show
Factors Influencing Risk of Patient
Safety Problems
First level of contact – general practice
► General practice varies
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► Number of patients served
► Services offered
► Specialist and secondary service support
► Diversity of patients
► Size and skill mix of professional team
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Emphasis has been placed on general practice
performing more complex care
► Diagnostic uncertainty
► Acting as care gatekeeper
► Emergency assessment
► Managing multiple co-morbidities
Building Safety Culture
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Strong safety centered general practice team includes…
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Commitment
► Staff buy-in to safety philosophy giving better care to patients
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Teamwork
► Everyone clear on contributions they make to improving safety
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Leadership
► Ability to assume ownership when problems arise
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Accountability
► Take responsibility for actions
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Understanding
► Look beyond blaming and identify the system factors
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Communication
► Be open to share good practice and voice concerns and opportunities
Methods for Safer Practice
► Several ways to improve safety
► Patient safety as a standing agenda item
► Reflect on results from audits
► Discuss learning from significant event audits and
incident reports
► Use technology to reduce risk
► Provide ways for everyone to give feedback
► Patients and staff
► Have a clear policy
Patient Safety Learning
Example of Incident Report
Example of Technological Safety
Alert
Patient Safety at a Glance:
Ch. 37
Population Health and
Improvement
Introduction
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Population Health
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Explores factors that determine health and disease in
populations
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Also works to develop/evaluate impact of interventions
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Need to define group of patients with common risk
factors, health goals, conditions
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Health outcome can be considered
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Health determinants can be identified
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Policies and interventions can be brought together
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Relies on information access
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Relies on willingness of stakeholders
Prevention of Cardiovascular Disease
► World Health Organization (WHO) strategy for
reducing cardiovascular disease (CVD)
► Focused on population-based approach
► Reduce risk factor level
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Example – relationship between salt intake and blood
pressure
► Reducing dietary sodium
► WHO estimates 49% of heart disease and 62% of strokes are
attributable to high blood pressure
► Western countries consume 10g of salt/day, twice
recommended level
► Prediction that in US, decrease of 3g salt/day would
reduce heart disease cases by 60,000, stroke by 32,000,
heart attack by 54,000 and death by 44,000
Barriers to Implementation
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Buy-in at clinical level is essential
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Barriers include…
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Time constraints
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Assumption that preventative strategies are ineffective
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Confusion over risk assessment tool
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Inadequate training
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Potential for adverse influences on clinician/patient relationship
UK Survey
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Found 1/3 with high cholesterol and ¼ with high blood pressure do
not take medication correctly
► Maybe due to side effects, poor information about benefits
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Telling someone they are at risk does not change behavior
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Patients prefer patient-centered approach
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RN coordinated prevention program involving dieticians, physical
activity specialists, cardiologists
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resulted in healthier diet, improved activity, more effective blood
pressure control
Opportunities
► Reducing CVD requires population-based
strategies
► UK, Finland, Portugal, Japan
► Reduced population-wide salt intake
► Combination of regulations on salt content
► Better food labeling
► Better education
► Provided opportunities for exercise
Conclusion
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Clinical and societal goal is to reduce preventative
disease
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Barriers to population-based efforts are opportunities
for improvement projects
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Model for Improvement used to learn how to adopt
evidence-based interventions
Questions?
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